BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

July 25 2018 Switching to sulfonylureas in type 2 diabetes has been linked with an increased risk...

Effect of omega-3 or other fatty acids on heart disease is negligible finds Cochrane review

Effect of omega-3 or other fatty acids on heart disease is negligible finds Cochrane review

July 19 2018 Cochrane researchers have published research indicating that omega 3 supplements...

DOACs associated with reduced risk of major bleeding compared to warfarin

DOACs associated with reduced risk of major bleeding compared to warfarin

July 11 2018 Direct oral anticoagulants (DOACs) have been associated with reduced risks of major...

Recorded penicillin allergy associated with increased risk of MRSA and C difficile

Recorded penicillin allergy associated with increased risk of MRSA and C difficile

July 3 2018 People who have a record of penicillin allergy are at an increased risk of developing...

MPS advises of need for better awareness of cauda equina red flag symptoms

MPS advises of need for better awareness of cauda equina red flag symptoms

May 9 2018 The Medical Protection Society is advising doctors of a revision to the NICE Clinical...

  • BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

    BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

    Wednesday, 25 July 2018 14:07
  • Effect of omega-3 or other fatty acids on heart disease is negligible finds Cochrane review

    Effect of omega-3 or other fatty acids on heart disease is negligible finds Cochrane review

    Thursday, 19 July 2018 10:36
  • DOACs associated with reduced risk of major bleeding compared to warfarin

    DOACs associated with reduced risk of major bleeding compared to warfarin

    Wednesday, 11 July 2018 13:22
  • Recorded penicillin allergy associated with increased risk of MRSA and C difficile

    Recorded penicillin allergy associated with increased risk of MRSA and C difficile

    Tuesday, 03 July 2018 16:51
  • MPS advises of need for better awareness of cauda equina red flag symptoms

    MPS advises of need for better awareness of cauda equina red flag symptoms

    Wednesday, 09 May 2018 16:01

scalpMarch 2 2016

Topical steroids, alone or combined with vitamin D, appear most effective with the least risk of side effects in treating scalp psoriasis, researchers have concluded.

While a combination product was considered more effective than the steroid alone, the clinical benefit was deemed questionable. However, steroids alone or in combination with vitamin D reduced scalp psoriasis better than vitamin D alone. In addition, “corticosteroids of moderate, high and very high potency are similarly effective.”

The findings come in a Cochrane review looking at the most effective topical treatments for the condition. The researchers assessed 59 randomised controlled trials (30 of which were conducted or sponsored by the product manufacturer) with a total of 11,561 participants.

Topical treatment interventions included steroids, vitamin D, corticosteroids in combination with vitamin D, corticosteroids in combination with salicylic acid, tar-based preparations, ciclopirox olamine, tacrolimus, cocois, and other combination products.

“Steroids and the two-compound combination of a steroid and vitamin D were most effective with the least risk of causing harmful side effects. Given the similar safety profile and only slim benefit of the two-compound combination over the steroid alone, topical steroids on their own may be fully acceptable for short-term therapy,” concluded the authors.

The meta-analysis also identified that:

  • participants who applied vitamin D stopped treatment more often because of harmful side effects than those who applied a topical steroid or the combination product;
  • steroids were as likely as the combination product to cause discontinuation of the treatment because of side effects;
  • compared to one another, steroids tended to be similarly effective and have similar side effects, even though some were of a higher strength;
  • there might not be a difference whether corticosteroids are used once or twice daily;
  • the most common harmful side effects of these treatments were irritation, itching and skin pain at the site of application;
  • steroids, vitamin D and their combination product were more effective than the vehicle preparation (cream, shampoo etc) that did not contain the active drug.

It was noted that most studies did not measure the improvement in quality of life, prompting the authors to say there is a strong need for more studies to assess this aspect of treatment.

In addition, there was not enough evidence to allow a final conclusion as to whether salicylic acid is of additional benefit in combination with corticosteroids, said the authors. “Few and mostly unreliable data suggest that the efficacy of tar or dithranol preparations is limited.”

Links:

Cochrane announcement

JG Schlager et al. ‘Topical treatments for scalp psoriasis’. Cochrane Skin Group. Published online February 26 2016.

Clinical News

July 27 2018 Adolescent boys will be offered the human papilloma virus (HPV) vaccine to protect them from cancer, the Department of Health and Social Care has announced.
July 20 2018 Doctors are being reminded to ensure that any patient or other records which may be relevant to the UK Infected Blood Inquiry are not destroyed. Earlier this month, the Inquiry’s Chair, Sir...